NICE has recently published an update to its guideline on the use of antibiotics to prevent infective endocarditis (IE). Although its advice remains that antibiotics should not be prescribed routinely to prevent IE in adults and children having dental and non-dental procedures, the guideline now links to further advice for certain groups with structural heart defects who are at higher risk of IE, and for whom preventive antibiotics may be appropriate when undergoing dental procedures.
The guidance now links to previously published advice from the Scottish Dental Clinical Effectiveness Programme for people at higher risk of IE. This guidance has been endorsed by a wide variety of cardiovascular organisations including the BCS, and is a welcome addition to the main guidance, providing clarity for these exceptional groups of patients.
NICE’s exceptional review of the guideline looked at new evidence published after the guideline was last updated in 2016. It confirmed that while there is some new evidence about the benefits of preventive use of antibiotics for people at higher risk of IE, this remains insufficient to change the overall recommendations in the NICE guideline, which seeks to balance the potential benefits of antibiotics with the risks of increasing anaphylaxis and antibiotic resistance.
The NICE guidance is available here:
https://www.nice.org.uk/guidance/cg64
The Scottish Dental Clinical Effectiveness Programme guidance is available here:
https://www.sdcep.org.uk/published-guidance/antibiotic-prophylaxis